chapter 26: Upper respiratory tract stuff Flashcards
Areas of concern
nose, sinuses, pharynx, larynx, and surgery for head and neck cancer
Deviated septum
- 80% of ppl have this a little, but diagnosis is for when it’s severe
-usually bc of trauma
-fucks with airflow and sinus drainage
Mild:
-nasal congestion and frequent sinus infections
-use saline rinses, decongestants, and analgesics
Severe:
-facial pain, nosebleeds, obstruction to nose breathing
-nasal sptoplasty might be necessary
Nasal fracture
-most common facial fracture
-simple fractures are usually uni- or bi-lateral and typically have little to no displacement
-complex fractures usually involve fucking up the rest of your face bones or your spine –> can cause meningeal tearing which leaks CSF –> may manifest as clear/pink drainage after management of bleeding
other signs are crepitus on palpation and difficulty breathing
Nursing management of nasal fracture
Maintain airway!
-keep the patient sitting upright
Reduce edema!
-apply ice to face for 10-20 min intervals
Control pain!
-give ordered analgesics (acetominophen or aspirin are goo NSAIDs for first 48 hrs)
Relieve stuffieness!
-nasal decongestants, saline nasal sprays, and a humidifier
Avoid complications
-no hot showers, alc, or smoking for first 48 hrs
Doctor management of nasal fractures
simple ones can be manually reset
complex ones –> you gotta wait 5-10 days for the swelling to go down
(maybe antibiotics if mucosa was disrupted)
septoplasty or rhinoplasty to reestablish airways and cosmetics
CAUTION: SEPTAL HEMATOMA ^^^ RISK FOR DEFORMITY AND INFECTION
Rhinoplasty
-surgery to improve airway func or for cosmetics
-patient will likely be concerned ab body image
-incisions are inside nose –> sonic rhinoplasty uses ultrasonic device to aspirate bone
-pack (1-2 days) and cast (1-2 weeks) the new nose
Special precautions before and after nasal surgery
Before
-Stop aspirin and NSAIDs 5-14 days before to reduce bleeding
-Stop smoking for a bit to encourage healing
After
-monitor pain, surgical site, and airway patency
-teach ab activity restriction: no nose blowing, swimming, heavy lifting, hard core workouts
***sometimes cosmetic endgoal takes a year
Epistaxis
who gets them?
why do they happen?
which ones are harder to treat?
ppl over 50
HTN, trauam, low humidity, URT infections, allergies, sinusitis, foreign bodies, chem irritants, anatomic malformations, tumors
posterior ones are harder to treat bc they’re far back and its hard to see how much blood is lost –> happens more in older adults
How to treat nose bleeds
-sit up, lean forward, hold nose for 5-15 mins, dont panic, get help if still bleeding
Anterior
-shove tampon with anesthetics or vasoconstrictive agents up there
-can also shove absorbent stuff up there –> “gelatin” stuff
-silver nitrate or thermal caterization
Posterior
-shove stuff deeper –> sponges, epistaxis balloons, 10-14F foley catheter w/ balloon
-2-3 days
-it hurts! give analgesics
-antibiotics bc of impaired mucosa
-nasal sling under nares
Post nose bleed care
cleanse and lube with water-soluble jelly
-teach ab saline nasal spray and humidifier
-caution agains aspirin and NSAIDs and nose blowing/extreme exercise for 4-6 weeks
Allergic rhinitis
-seasonal
-perennial
episodic
intermittent
-persistant
inflammation of nasal mucosa in response to allergen
-Seasonal = spring and fall from pollen and plants
-Perennial = year round
-episodic = sporadic exposure to allergen–> not part of every day life
-intermittent = symptoms are there less than 4 days a week or 4 weeks a year
-persistent = more than 4 days a week or 4 weeks a year
science behind allergic rhiitis
-after initial exposure to allergen, the body makes IgE against it
-at subsequent exposures, mast cells and basophils make histamie, cytokines, PGs, and leukotriens
-4 to 8 hrs later, inflammatory cells go to nasal tissue causing and miantainig allergic reponse
some ppl think its a recurrent cold
manifestations of allergic rhinitis
-sneezing, watery/itchy eyes/nose, poor smell, thin/watery nasal drainage
-nasal turbinates are pale, boggy, and swollen
-turbinates fill and press against nasal septum –> can obstruct sinus drainage (sinusitis)
-nasal polyps and post nasal drips = cough
Allergic rhinitis treatment
identify and avoid allergen
nasal corticosteroid sprays!!!
oral meds: H1 antihistamies, decongestants, leukotriene receptor antagonists
intranasal meds: anitihistamines, anticholinergics, corticosteroids, cromolyn, and decongestants
immunotherapy (allergy shots) if specific, unavoidable allergen can’t be effectively treated
which antihistamines are better?
second generation –> they don’t cause sedation
Acute viral rhinopharyngitis
common cold / nasopharyngitis
-most prevalent infectious disease –> ppl get 1-3 per year
usually coronavirus, RSV, or enterovirus
-droplet (and kinda contact) spread –> worse with overcrowding
-symptoms start 2-3 days aft infection and last up to 2 weeks
risk factors = fatigue, stress, allergies, immunocomprimise
How to treat acute viral rhinopharyngitis
-rest, fluids, antipyretics, analgesics
for sore throat
-warm salt gargles, ice chips, lozenges, or sprays
for cough
-antihistamie and decongestant therapy reduce postnasal drip
-dont use decongestant spray more than 3 days –> rebound congestion
vit C, echinacea, and zinc aren’t proven to help
Teach patients to recognize signs of secondary bacterial infections
complications of acute viral rhinopharyngitis
acute bronchitis
sinusitis
otis media
tonsilitis
pneumonia
Go to HCP if symptoms last over 2 weeks
Influenza
Super contagious rep illness that kills ppl –> GET VACCINATED
4 serotypes: A, B, C, and D
droplet spread
incubation = 1-4 days (peak contagiousness on day 3)
symptoms last 5- 7 days
Influenza A
most common
has 2 surface proteins: H helps enter cell; N helps w/ cell-to-cell transmission
infects a lot of animals
mutates to affect humans –> causes pandemic or epidemic bc ppl’s immune systems aren’t used to it
Influenza B and C
B and C only affects humans
No subtypes
B sometimes causes epidemics, but milder than A
C causes mild symptoms, but not epidemics
D only affects animals
Influenza manifestations: complicated and uncomplicated
uncomplicated:
-similar to a cold
- abrupt onset
-headache, cough, sore throat fatigue
-normal breath sounds and chest ascultation
complicated:
-pneumonia from primary influenza or secondary bacterial infection (and ear/sinus infection)
-dyspnea and crackles
-if bacterial pneumonia, influenza gets better, but cough and purulent sputum gets worse
diagnosing influenza
-not using viral cultures as much
Rapid influenza diagnostic tests (RIDTs)
-can detect influenza from resp secretions in 5 mins
-best if done w/in 48 hrs of symptoms onset
-sometimes inaccurate
contraindictions to influenza vaccine
severe allergic reactions to past ones
egg allergy –> there’s alternatives for ppl like this though
anitviral meds for influeza
Neuraminidase inhibitors preventing spread to other cells
Zanamivir (Relenza) –> inhaler
Oseltamivir (Tamiflu) –> capsule
Peramivir (Rapivab) –> IV
New drug
baloxavir marboxil (Xofluza) –> PA endonuclease inhibitor that stops viral replication –> oral
Sinusitis
Affects 1/7 adults –> inflammation blocks ostia to sinuses
-build up of fluid in sinuses promotes bacterial infections
-often follows URT infection where ciliary action is decreased
If symptoms worsen after 3-5 days or last longer than 10 days, secondary bacterial infection is probably present (5-10% of the time) –> streptococcus pneumonia, moraxella, haemophilus influenzae
